Nephrology: Fellowship Program
The goal of our renal resident program is to develop, during a three year period, academic pediatric nephrologists committed to the care of infants, children and adolescents and young adults with all types of renal disease, including those with acute and chronic renal failure, as well as those requiring dialysis and transplantation. This will also include an understanding of the pathophysiology and treatment of fluid, electrolyte and acid-base regulation disorders. We foster an environment that facilitates the acquisition of the clinical and basic research skills necessary to make significant contributions to the understanding of the pathophysiology and treatment of diseases that affect the kidney. Renal residents will also be expected to learn how to select, perform and evaluate procedures, including the renal biopsy, radiology testing, and the operation of dialysis equipment. Also necessary is an understanding of the psychosocial aspects of acute life threatening and chronic renal diseases and their effect on the patient, family and other significant people in their lives. Renal residents will gain administrative experience in the operation of a renal program, including staffing and working with dialysis unit and other clinical staff. They will be trained in the proper communication with patients, families, physicians and other staff, including the writing of referral letters. Compliance and cost/benefit issues will be covered during all three years of training. Grant writing will be both a formal and informal experience. Finally, we expect our renal residents to gain experience in becoming excellent teachers.
Renal residents will have an opportunity to see patients with the supervision of four sub-board certified pediatric nephrologists and numerous other pediatric sub-specialty consultants. The renal patients will include inpatients and outpatients, as well as those on all types of dialysis (peritoneal, hemodialysis and CRRT). Renal residents will have training in a wide variety of complex renal diseases, the majority of which will include hematuria, proteinuria, enuresis, hypertension, urinary tract infections, cystic disease, lupus erythematosis, a variety of glomerular diseases, obstructive uropathies, vesicoureteral reflux, nephrotic and nephritic syndrome, renal and bladder calculi, abnormalities in fluids and electrolyte balance, renal tubular diseases, hereditary renal disease, tumors of the genitourinary tract and kidney, acute and chronic renal failure, renal transplantation, and perinatal and neonatal conditions. They will also participate in providing consultation to all other pediatric services with patients that have associated renal problems.
There is a large patient population available to renal residents for patient care, teaching and research. There are approximately 250 pediatric renal admissions each year and 150 consultations with an average length of stay of 5.2 days. Fifteen to twenty renal transplants are performed each year along with numerous other transplants of the lung, heart, liver and bone marrow for which we are often asked to consult for associated renal problems. Renal residents will have an opportunity to participate in renal biopsies, which average approximately 86 each year. There are an average of eight patients on chronic hemodialysis, an additional two per week being acutely dialyzed and an average of six patients on outpatient peritoneal dialysis. The peritoneal dialysis patients are seen in clinic once each month or any time they have a medical problem.
Renal residents will have an opportunity, with the supervision of a pediatric nephrologist, to see some of the 3000 renal outpatient visits per year. Clinic is held Monday through Friday.
Training renal residents to become effective teachers is a very important goal of our program. This is vital to preparing them for careers in academic pediatrics. Renal residents will be given many opportunities to teach both formally and informally. This will include lecturing in the classroom and at the bedside to nurses, medical students, residents, allied health professionals, residents in other subspecialties, etc. The renal division has two didactic seminars/journal club meetings weekly, a weekly patient care conference, a quarterly radiology conference, and a pathology slide conference to review renal biopsies at least twice each month.
Clinical and Research Training
At least one year of the pediatric renal resident’s training will be dedicated to clinical and/or basic research depending on future plans and interests of the renal resident and the type of mentor available. To complete the renal program, we will require the renal resident to have at least one peer-reviewed publication.
The first year of the program will be clinical with five months in the out-patient clinic and five months on the inpatient service. There is one month devoted to research. The subspecialty resident will be assigned a research mentor. Plans will be made to write a research grant. There will be fifteen vacation days and ten sick days this year.
The second year will be both clinical and research. The renal resident will spend five months in the clinic (three months 100% and two months 20%), and two months on the inpatient service. Each subspecialty resident has 2 weeks of one month on the radiology service, at least two weeks on the renal biopsy service, and 2 weeks in urology clinic. The subspecialty resident will have at least five months of research at 100% time. There is also an opportunity to prepare a case report to submit for publication. There will be fifteen vacation days and ten sick days this year.
The third year will be dedicated mostly to clinical and/or basic research. The goal will be to conduct research that will at a minimum result in the publication of at least one first-authored peer reviewed article. Secondary to this he/she will be expected to submit the results for presentation to a regional or national scientific meeting, as well as, at the annual Pediatric Science Day Program. The subspecialty resident will have three months on the inpatient service, one month of outpatient clinics (100%) and three months of 20% outpatient clinic time. The subspecialty resident will have seven months of research at 100% time and three months at 80% time. There will be fifteen vacation days and ten sick days this year.
The renal resident will have an Advisory Committee to review his progress every six months. This will be done utilizing two evaluation letters. One letter written by the Program Director in conjunction with the other renal faculty. The other letter will be written by the renal resident offering his/her insights as to her/his progress and the support received.
Graduated Levels of Responsibility
Graduate medical education is based on the principle of progressively increasing levels of responsibility, in caring for patients, under the supervision of the faculty. The faculty is responsible for evaluating the progress of each resident in acquiring the skills necessary for the resident to progress to the next level of training. Factors considered in this evaluation include the resident’s clinical experience, judgement, professionalism, cognitive knowledge and technical skills. These levels are defined as postgraduate years (PGY) and refer to the clinical years of training that the resident is pursuing. The requirements for training in the primary care specialties such as pediatrics, internal medicine and family practice call for three years of training. Subspecialty training, traditionally called fellowship, includes considerable autonomy especially in the tasks already mastered in the core program. At each level of training, there is a set of competencies that each resident is expected to master. As these are learned greater independence is granted the resident in the routine care of the patient at the discretion of the faculty who, at all times, remain responsible for all aspects of the care of the patient.
Fellowship Program Director
Lawrence Shoemaker, MD
Professor and Chief, Division of Pediatric Nephrology
Gainesville, Florida 32610-0296
Office: (352) 273-9180
Fax: (352) 273-9028